Cerebellopontine Angle Glioblastoma with Concurrent Spinal Cord Involvement: A Case Report and Review of Literature

Abstract

Objective: To report a unique case of cerebellopontine angle glioblastoma with concurrent spinal cord involvement. Background: Glioblastoma (GBM) is the most common primary malignancy of the central nervous system (CNS), comprising 46.6% of all CNS malignancies. By anatomic location, cerebellopontine angle (CPA) GBMs are exceedingly rare. To our knowledge, the following case represents the tenth reported case of CPA GBM and the first with a corresponding spinal cord tumor on presentation. Methods: Retrospective chart review was conducted for a patient with CPA GBM. The patient consented to the publication of her diagnostic studies. Result: A 43-year-old female presented with a 3-month history of right ear hearing loss. Brainmagnetic resonance imaging (MRI) demonstrated a right CPA mass as well as a cervical spinal cord mass of unknown histology. Pathology showed GBM, IDH wildtype and negative for the H3 K27M mutation, while the cervical spinal cord lesion was not amenable to biopsy. She received proton beam therapy with 60 Gy to the GBM and 50.4 Gy to the spinal cord tumor in 30 fractions each with concurrent Temozolomide. She received 2 cycles of adjuvant Temozolomide prior to her demise due to progressive disease. Conclusion: There are four possible origins of CPA glioblastoma: the cerebellum, brainstem, root entry zone of cranial nerve VIII, and heterotopic glial cells of the leptomeninges. Prognosis does not appear to depend on tumor origin. Outcomes are likely optimized by maximal safe resection followed by radiation and concurrent Temozolomide. Spinal cord involvement of malignant tumors can significantly adversely affect survival outcomes in such patients.